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Safety of stereotactic ablative body radiation for ultracentral stage I non-small cell lung cancer.

ABSTRACT: Recent data suggests that "ultra-central" tumors, generally defined as those abutting the proximal airways, are at particularly high risk for severe complications when treated with stereotactic ablative body radiation (SABR). However, this association has not been consistently demonstrated across reports, possibly due to small numbers, varying definitions of "ultra-central", and the lack of prospective data. New evidence suggests that exposure to VEGF-inhibiting agents may potentiate SABR toxicity and may partially explain the disproportionately high incidence of fatal complications in some reports. Efforts are underway to identify dose-volume limits that can predict complications involving central structures such as the proximal airways, heart, esophagus, and great vessels. The optimal dose for ultra-central SABR has not been determined, though there is a trend towards using more highly fractionated regimens. Further research into the safety of SABR for ultra-central tumors is needed, given the lack of other effective local therapy options for this clinical scenario.

SUBMITTER: Wu AJ

PROVIDER: S-EPMC6795582 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Safety of stereotactic ablative body radiation for ultracentral stage I non-small cell lung cancer.

Wu Abraham Jing-Ching AJ

Translational lung cancer research 20190901 Suppl 2

Recent data suggests that "ultra-central" tumors, generally defined as those abutting the proximal airways, are at particularly high risk for severe complications when treated with stereotactic ablative body radiation (SABR). However, this association has not been consistently demonstrated across reports, possibly due to small numbers, varying definitions of "ultra-central", and the lack of prospective data. New evidence suggests that exposure to VEGF-inhibiting agents may potentiate SABR toxici ...[more]

PMID: 31673517

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Project description:PurposeFor inoperable stage I (T1-T2N0) small cell lung cancer (SCLC), national guidelines recommend chemotherapy with or without conventionally fractionated radiation therapy. The present multi-institutional cohort study investigated the role of stereotactic ablative radiation therapy (SABR) for this population.Methods and materialsThe clinical and treatment characteristics, toxicities, outcomes, and patterns of failure were assessed in patients with histologically confirmed stage T1-T2N0M0 SCLC. Kaplan-Meier analysis was used to evaluate the survival outcomes. Univariate and multivariate analyses identified predictors of outcomes.ResultsFrom 24 institutions, 76 lesions were treated in 74 patients (median follow-up 18 months). The median age and tumor size was 72 years and 2.5 cm, respectively. Chemotherapy and prophylactic cranial irradiation were delivered in 56% and 23% of cases, respectively. The median SABR dose and fractionation was 50 Gy and 5 fractions. The 1- and 3-year local control rate was 97.4% and 96.1%, respectively. The median disease-free survival (DFS) duration was 49.7 months. The DFS rate was 58.3% and 53.2% at 1 and 3 years, respectively. The median, 1-year, and 3-year disease-specific survival was 52.3 months, 84.5%, and 64.4%, respectively. The median, 1-year, and 3-year overall survival (OS) was 17.8 months, 69.9%, and 34.0% respectively. Patients receiving chemotherapy experienced an increased median DFS (61.3 vs 9.0 months; P=.02) and OS (31.4 vs 14.3 months; P=.02). The receipt of chemotherapy independently predicted better outcomes for DFS/OS on multivariate analysis (P=.01). Toxicities were uncommon; 5.2% experienced grade ≥2 pneumonitis. Post-treatment failure was most commonly distant (45.8% of recurrence), followed by nodal (25.0%) and "elsewhere lung" (20.8%). The median time to each was 5 to 7 months.ConclusionsFrom the findings of the largest report of SABR for stage T1-T2N0 SCLC to date, SABR (≥50 Gy) with chemotherapy should be considered a standard option.

Project description:IntroductionThe present study explores changes in pulmonary function, symptoms and radiological signs of pneumonitis after curatively intended stereotactic body radiation therapy (SBRT).MethodsAll inoperable, early-stage non-small cell lung cancer patients treated with stereotactic body radiation therapy (SBRT) from 2014-2017 were included in this single-centre study. They were followed regularly for 12 months after treatment. The patients were classified into three groups based on radiology and symptomatology: no radiation pneumonitis, asymptomatic and symptomatic radiation pneumonitis.ResultsForty-four patients with stage IA-IIB disease were treated with 45-56 Gy in 3-8 fractions. The median age was 75 years, 43% of the patients were female; 60% of the patients had a COPD in GOLD grade of 2-4, and 95.5% were active or former smokers. Symptomatic radiation pneumonitis occurred in 18% of the patients and asymptomatic pneumonitis as defined by radiology, in 39%. The mean of forced expiratory volume in 1 second (FEV1) and diffusion capacity for carbon monoxide (DLCO) decreases for all patients during the first years were higher than one would expect from physiologic ageing. FEV1 and DLCO in percent decrease 7-8% at 1-1.5 months in the symptomatic radiation pneumonitis group. CT scan findings consistent with radiation pneumonitis occurred after a median of 2.9 months in the symptomatic and 5.4 months in the asymptomatic radiation pneumonitis groups. In the group with symptomatic radiation pneumonitis, symptoms, as measured by the Clinical COPD questionnaire score, significantly increased at 3 and 6 months. Significant higher maximum doses to the critical lung volumes DC1000cm3 (1000 cm3 of lung receiving a given dose or less) and DC 1500cm3 (1500 cm3 of lung receiving a given dose or less) were observed in patients who developed radiation pneumonitis.ConclusionEarly decrease in measured FEV1 and DLCO occurred before imaging changes and symptoms and might indicate the development of symptomatic radiation pneumonitis. The dose to critical lung volumes of DC1000 cm3 and DC1500 cm3 may predict the risk for the development of symptomatic radiation pneumonitis.

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Safety of stereotactic ablative body radiation for ultracentral stage I non-small cell lung cancer.

Publications

Safety of stereotactic ablative body radiation for ultracentral stage I non-small cell lung cancer.

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